Provider Demographics
NPI:1669567665
Name:HARDEE, GREGORY D (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:HARDEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102HIGHLAND AVE SE
Mailing Address - Street 2:SUITE 455
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24013
Mailing Address - Country:US
Mailing Address - Phone:540-985-9910
Mailing Address - Fax:540-985-9916
Practice Address - Street 1:102 HIGHLAND AVE SE
Practice Address - Street 2:SUITE 455
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-2256
Practice Address - Country:US
Practice Address - Phone:540-985-9910
Practice Address - Fax:540-985-9916
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036158207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0338563OtherANTHEM
VA006252800Medicaid
VA006252800Medicaid
C47661Medicare UPIN